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Patient Information > Gynaecological > Vulvodynia
Vulvodynia |
Vulval pain can affect any woman of any age and the condition can last anything from three months to several years. For some the pain may resolve by itself but others may battle with symptoms for a long time.
Most doctors including many gynaecologists may never have heard of vulvodynia. There is a lack of knowledge in the medical community and the majority of health professionals are slow to learn about the disorder (Glazer H, Rodke G, 2002). The few professionals who do recognize and treat vulval pain generally do not take an integrated medical approach. This is similar to other pelvic pain conditions. These conditions cross many fields of medicine: gynaecology, urology, gastroenterology, neurophysiology, rheumatology, immunology, pathology, psychology etc. Each specialist will see what they know most about and use the treatments they are most familiar with for example a urologist may concentrate on urinary symptoms of urgency and frequency associated with interstitial cystitis while a neurologist is more likely to find pain caused by nerve damage or pudendal neuralgia.
Vulvodynia means pain in the vulva. The vulva is the tissue outside of the vagina including the vaginal opening, the labia, the clitoris, urethra and the mons pubis. It is defined as “vulval pain in the absence of relevant, visible physical findings, or a specific, clinically identifiable neurologic disorder”. However neuropathic pain arising from nerve damage or trauma may go undiagnosed for a long time unless the patient has access to a clinician who is experienced in this field. Pain may also be due to causes including infections, skin conditions, hormone depletion and occasionally precancerous or malignant conditions.
Generalized vulvodynia
The pain in this condition may be constant and is not triggered by anything specific. Pain can affect the whole of the vulval region. This may be caused by the pudendal nerve as in pudendal neuralgia. See neurological information
Localized vulvodynia (previously called vestibulitis)
This can affect any site on the vulva, Sexual intercourse is a frequent provoking trigger for the symptoms. Pain during intercourse is known as dyspareunia. Inserting tampons can be difficult. (deeper pains in the vagina and pelvis are associated with different problems such as endometriosis, fibroids and urinary or bowel disorders such as interstitial cystitis or irritable bowel syndrome ). Some women describe recurrent symptoms with cycling, horse riding or wearing tight clothing.
Recent data suggests that this pain may arise from persistent inflammatory damage to tissue. Some women may make more chemicals that increase or cause inflammation. Irritation causes the release of chemicals (cytokines) which make nerve endings sensitive. When nerves are sensitized, normal touch or pressure can create pain. This is known as allodynia. There is research indicating an increase in the number of nerve fibres in the vulva of those with this condition (Bohm-Starke et al 1998). An increase in the number of nerves could lead to an increased inflammatory response. In addition tissue samples from those with this condition have higher levels of substances that cause inflammation (Sloane et al. 1999). Biopsies show an increase in the number of mast cells (Bornstein 2001) which could lead to hyperalgesia (supersensitivity to painful stimuli meaning that sufferers feel more pain than normal)
Persistent infections may cause irritated vulvar tissue. Over-the-counter preparations may make the condition worse and anti-fungal creams can irritate the skin and may play a role in the onset of vulvodynia.
Patients may also have other coexisting conditions such as Irritable bowel syndrome (IBS), Interstitial Cystitis (IC), fibromyalgia, CRPS, and other autoimmune/inflammatory diseases.
Many of these conditions relate to mucosal tissue where there may be a more extreme physical response to inflammation in the tissue.
Many sufferers worry that they may not be able to create or maintain intimate relationships in their lives due to their vulval pain. However many women with vulval pain are able to maintain long term stable relationships.
The International Association for the Study of Pain (IASP) has produced a factsheet on Vulvodynia for the global year against Pain in Women.
References:
The urogenital and rectal pain syndromes. U Wesselmann et al Pain 1997;73:269-294
Women's sexual pain and its management. Weijmar Schultz W et al J Sexual Med 2005;2, 301-316
The message board has a section for vulval pain conditions:
http://www.pelvicpain.org.uk/forum/index.php
